The effect of repetitive transcranial magnetic stimulation on symptoms in obsessive compulsive disorder

Abstract

Background:Within a decade, the Repetitive Transcranial Magnetic Stimulation (rTMS) was being used to treat depression and schizophrenia. Antidepressant response has been reported in open and double-blind, sham-controlled studies of depression. Less is known about rTMS efficacy in the obsessive compulsive disorder.Method:The aim of the randomized, double-blind, sham controlled study was to compare the 2 and 4 week efficacy of the 10 sessions rTMS with sham rTMS in serotonin reuptake inhibitor resistant OCD patient. Thirty seven right-handed patients were randomly assigned to either active rTMS or to sham. Active rTMS with the frequency of 1 Hz at 110% of motor threshold was administered over the left dorso-lateral prefrontal cortex. The same time schedule was used for sham administration. Thirty three patients finished the study, three patients’ dropped out at the beginning. Psychopathology was assessed by CGI, HAMA, Y-BOCS and BAI before the treatment, immediately after the experimental treatment, and 2 weeks after by an independent reviewer.Results:Both groups improved during the study period but the treatment effect did not differ between them in any of the instruments.Conclusion:Low frequency rTMS administered over the left dorso-lateral prefrontal cortex during 10 daily sessions did not differ from sham rTMS in facilitating the effect of serotonin reuptake inhibitors in OCD patients.Supported by the project n. MŠMT ČR 1M0517

Reductions in cortico-striatal hyperconnectivity accompany successful treatment of obsessive-compulsive disorder with dorsomedial prefrontal rTMS

“…Previous studies of rTMS in OCD have encountered little therapeutic benefit with stimulation of lateral prefrontal targets such as the dlPFC (Alonso et al, 2001;Prasko et al, 2006;Sachdev et al, 2007;Sarkhel et al, 2010), but somewhat more success with medial prefrontal targets such as the SMA or pre-SMA (Mantovani et al, 2006(Mantovani et al, , 2010aKumar and Chadda, 2011). The results of the present study are congruent with this latter literature in suggesting that rTMS of a slightly more anterior medial prefrontal target, the dmPFC, can also yield substantial symptom reduction in a proportion of OCD cases, even when multiple previous medication trials have failed.…”

Review of structural neuroimaging in patients with refractory obsessivecompulsive disorder

“…TMS is a noninvasive technique that delivers magnetic pulses directly to the scalp. To date, several trials of TMS on OCD patients have been published, with promising results [39][40][41][42][43] . Stimulation of the right and the left prefrontal cortex [41] and of the supplementary motor area [42] has shown beneficial effects in treatment-resistant OCD patients, with response rates ranging from 25% to 60%, as measured by Y-BOCS.…”

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…In double-blind studies with sham rTMS as control, rTMS over the left dorsolateral prefrontal cortex was ineffective (Prasko et al 2006b;Sachdev et al 2007). Also, right prefrontal rTMS failed to produce significant improvement of OCD and was not significantly different from sham treatment.…”